IN speaking to this critical Point, I shall first give the Reason of such a BIRTH, occasion’d by this Position; to wit, The WOMB hanging much forwards, especially in Women carrying it too low in the Abdomen, the INFANT (betwixt the Pains) must needs be forced upon the Os Sacrum, or the Vertebræ bending inwards; which stops the Head that it cannot conveniently or without Obstruction fall into the Pelvis.
HOWEVER, in this Condition we suppose the INFANT to be well turn’d, I mean (both here and elsewhere) well turn’d in respect of the WOMB, with the Crown of the Head lying against the Orifice; than which nothing can be more Right or Natural in regard of the WOMB itself, nor more Wrong and Preternatural in respect of the PELVIS and Vagina of the WOMB, in this forward Situation: Because by reason of this Posture, the INFANT falls transverse upon the Ossa Pelvis, especially upon the Os Sacrum or hindmost Vertebræ; upon which it commonly offers itself with the Face prone or turn’d Downwards, tho’ it is not brought forth, but with the Face Supine or Upwards. For as it passes, it must be turn’d round, partly in a Circle, with its Head prone, and Feet drawn up under it; which happens not in the WOMB, but only as it passes the Orifice into the PELVIS or VAGINA.
NOW what I mean is more plainly This, that as soon as the Infant comes into the Turning (which it must pass) it necessarily bends and crooks itself, as it finds its Passage bent or crooked; by which means the Face is sometimes turn’d down, and sometimes upwards: And This proceeds from That, in short, as soon as the Head begins to enter the Orifice, it presently fixes upon (and sticks fast to) the last Vertebræ of the Loins standing forwards, or to the Os Sacrum; so that it cannot naturally or possibly go forwards, except the Head is bent downwards, and the Neck and whole Body be accommodated to that Bending.
HENCE it is, that THAT which just now was situated prone upon its Belly in the WOMB, now passing through the VAGINA, is bent upwards supine upon its BACK; and from thence it’s evident, that That Inversion is not properly in the WOMB, but in the VAGINA, or (if you please) in the Confines of Both: And, in fine, this forward Inversion (as it happens) occasions a most difficult Preternatural BIRTH.
BUT this, in short, happens to the Woman with CHILD, because her WOMB hangs forward, or is resupin’d, according to the Depression made on the WOMB by the Intestines, forcing it this or that way; or to either Side, as will by and by more fully appear[173]. But——
SINCE it is most requisite to know presently in the Beginning of LABOUR, whether the WOMB be placed forwards, in order that the Means of Help may be taken accordingly; I shall in the second place add the SIGNS, or Tokens, by which the MIDWIFE may know this Position of the WOMB, and what she has best to do in such a nice ticklish STATE of Affairs.
FIRST then, She may know it, principally, by the Hanging forwards and Thickness of the Belly, or perhaps by the good Woman’s Information of the Place, where she chiefly feels the INFANT stirring; for it cannot move but where ’tis placed.
HOWEVER yet a prudent MIDWIFE will have no great regard to such Uncertainties, but betake herself immediately to that which cannot fail her, the Touch; which (in this Case) affords her the following certain SIGNS; viz.
I. THE Orifice of the Womb is suspended higher than usual; which she cannot Touch, by reaching, without a great deal of Difficulty.
II. SHE can only Touch the lower Border of the Orifice, and that only as the Womb hangs more or less forwards; and by no means the upper Edge, except the Orifice has begun to fall down.
III. SHE cannot at all, or very hardly, get her Finger into the opening of the Orifice, and because of that Difficulty, it must then also be crooked or bent.
IV. SHE will find the Orifice opposite to the bending of the last Vertebræ or the Os Sacrum, and feel it so strongly pressed against the said Vertebræ, when the Pains come on, that it cannot fall down: and lastly, she’ll feel the Waters (if they hang over the Passage) in a thin slender Form.
UPON This the Skilfull MIDWIFE finding these concurring SIGNS, she may be assur’d that the Womb hangs too much forwards; which Condition requires the immediate Help of Ingenuity and ART to correct this ill untoward Position, and to promote the BIRTH expeditiously. But then these Things are to be carefully perceived and distinguished in the Beginning of Labour, before the Pains have either closed up, or too much depressed the Orifice; yea, in short, even before it sensibly opens: since afterwards all those SIGNS are variously chang’d and alter’d, till at last they entirely vanish.
WHEREFORE let it be deem’d as a certain Rule, that the true Posture of the WOMB is always best discover’d by the Touch in the Beginning of the Labour: At which time may the Orifice be suspended never so high, the MIDWIFE ought to penetrate so far, until she reaches it; if not sufficiently with her Fingers, the whole Hand is to be judiciously used, and passed up that Length, because this particular Touch is absolutely Necessary for that good End: Insomuch that if any Labouring Woman be against this manual Operation or opposes it, she thereby debars her MIDWIFE of an infallible Method, of discovering the true Posture of her Womb, and consequently of taking the most immediate proper Means for Her own as well as her Infant’s Relief.
BUT now supposing, after all, the MIDWIFE to be certain that the Womb hanging too much forwards, in a prominent Belly bearing pretty much out, is deeper depressed than it ought to be; She is obliged then in this Circumstance to consider accordingly how to correct this Preternatural Situation, and assist both the Mother and Infant for the best: To which End, She ought First to endeavour that the Head may fall down into the Pelvis, even to the bending of the Os Coccygis; and then, Secondly, She is thence to advance the Head gradually, that the Exclusion of the CHILD may be expedited and intirely perfected at last.
NOW in order that the Head, together with the Orifice of the Womb, may be so discreetly brought forwards into the Pelvis, the Woman is to be placed with the upper part of her Body lower than the inferiour; I mean, with Head and Shoulders bending downwards, and the Buttocks upwards; by which Means, the Bottom of the Womb is elevated, and gives the Orifice an Opportunity of being brought more easily into the Pelvis.
THEN the parturient Woman being so placed, the MIDWIFE (using both Hands) ought to clear the Womb, together with the Head of the Infant, by putting the one up, as far as there’s occasion, into the Vagina, and laying the other upon the Woman’s Belly, in manner following: viz.——
THE Hand in the Vagina is (by having two or three of its Fingers Ends extended to the upper Border of the Orifice of the Womb) to move it a little beyond the Head of the CHILD, and to direct it into the Mouth of the Pelvis, so that it may fall the more readily down into the design’d Place. But in this critical Juncture the MIDWIFE must always take special Care not to squeeze or press the Top of the Head too much, nor to handle it too hard, lest She should thereby wound, if not also kill the Infant.
AGAIN the Business of the other Hand, used externally, is to drive back the Womb, by pressing the Abdomen; which must be perform’d also with great Caution and Judgement, not by drawing the Hand from above downwards, but pressing as much as the Woman can bear it, from below upwards; so that (if possible) the Womb may be thereby resupin’d or turn’d backwards. Minding always, by the way, that
THIS Pressure of the Womb is not to be attempted, before the one Hand is first conveniently placed within. But if all This Menage should not yet succeed the first time according to Wish, then it may be safely repeated again by turns so often, until the MIDWIFE feels the Crown of the Head; that is to say, till She feels the Borders of the Orifice quite round about hanging over the Entrance of the Pelvis. Upon which happy Discovery, she may with reason rejoice in her Labour, and be heartily glad of her good Success: Because now the Force of good depressing Pains only will effectually perfect the Work.
BUT before Matters are happily brought this prepared Length, the bearing Woman is upon no account to begin her LABOUR; since That would not only be in vain, and otherways debilitate the Strength of her Body; but also be of great Hindrance to the Midwife (to whom all the LABOUR hitherto belongs) who, as she feels the PAINS growing and rushing in upon the Woman, before their proper Time, ought to charge her strictly, to forbear working along with them, and as much as possible to abstain from any co-operating Depression. And in fine, as the MIDWIFE by having her Hand diligently apply’d to the Orifice of the Womb, by strict Attention, may most commonly observe, and previously discern the approaching PAINS, before the Patient Woman herself can be sensible of them: So she ought also for her own helping Part, ex Officio, to be quiet and attempt nothing till Then, but take her convenient Opportunities, always as soon as the PAINS are over.
THUS by seasonably lending Nature an artificial helping Hand, Both jointly may easily effect, what neither can do separately: For as it sometimes happens, that the MIDWIFE ought to cease, while she perceives (by the Pains) that Nature is a working, and therefore ought to work only when the PAINS are past; so it also falls out often, upon other Occasions, that she is to work along with the PAINS, and when those are past, to cease. And thus, in fine, according to different Circumstances, the discreet MIDWIFE knows always the Needfull, what’s to be done, or let alone.
BUT in this Place, I doubt not, many MIDWIVES will object, and say, How is it possible for Us to perceive the PAINS coming on before the parturient Woman herself? To which I ingenuously answer, that This also is one of the many Advantages of the Touch; since by That, I can presently feel a kind of subtile Motion, Contraction, or Compression beginning in the Orifice of the Womb; which is only observable as the Muscles are affected with a New Sense, excited by a New Influx of the Spirits; occasioning a New Force or Impression upon the Womb, which we commonly call a Pang: So that, in short, by distinguishing this Motion from others, I am always able to foretell or advise the Woman of what is a-coming, and to admonish her accordingly of her bounden Duty, as the Case requires.
MATTERS now being fairly brought thus far, that the Orifice and the Head begin to slide down into the PELVIS; the MIDWIFE is at this Time to study how to succour and assist the CHILD, by rendring its Passage easy. In order to which, she must first observe to raise the upper Part of the Woman’s Body a little, and give her some short Respite, before she offers to bring the Orifice into the PELVIS; because the Posture above-directed, occasions considerable Pain as well as great Inconveniency: Which being done, the Woman for the future is to sympathize with every PAIN, and Labour as much as possible, co-operating mutually with them; since now the Pains (by the Assistance of the Head) begin to open the Orifice, and gradually force the Infant forward to its Birth.
HOWEVER yet the MIDWIFE ought in this Case, to be very careful in sustaining, and nice in keeping up the Orifice of the Womb, lest it should fall down together with the Vertex or Crown of the HEAD into the Sinus Sacri; which is a Point so curious and critical, tho’ an Accident too common, that I dare well say, not one in Fifty Practitioners in MIDWIFERY understands it thoroughly; otherways I am confident, and morally certain, that many fine Women would have been living Monuments of their Ingenuity, who are at this day only the Dead Remains of their Ignorance.
THIS I think is past all Contradiction, when we consider, how some Practisers sacrifice the Infant, first by opening, and (as they call it) braining the HEAD, and then by drawing it forth with their Instrument call’d FORCEPS: How others also esteem themselves Masters of the greatest ARCANUM, boasting that they can, without so much as braining the HEAD, extract the INFANT by their Tool call’d an EDUCTOR: How a Third Set again pretending themselves to be the only genuine Sons of Apollo, come slily to correct the Rest, by fixing only a couple of Hooks in the Eyes, Ears, or somewhere else in the Child’s HEAD; by which means they as wretchedly produce the innocent dead Babe as any of the others: For it can no more be suppos’d to survive this cruel Treatment, than the other mentioned Barbarities; not to speak of the Anguish and Perplexity over and above, besides the real Danger all the while brought upon the distressed Mother.
UPON this grand Affair of Life and Death, the Desidious and Capricious MIDWIFE cries at length, God knows I have taken all the Pains and Care I could, but to no Purpose, for this or that trifling Reason, falsely alledged. The SURGEON (if he don’t pretend the CHILD to be already Dead) says, Come, it is better to dispense with one Life than Two; One must go, &c. In consequence of which, he prepares his FORCEPS, EDUCTOR, KNIVES, HOOKS, &c. to draw out the INFANT Dead, or Alive, Whole or in Pieces, by such disingenuous and barbarous Means to save the MOTHER. Thus behold the excellent Art of MIDWIFERY ignorantly perverted! O Deplorable Woman! O Miserable Babe! How much abused! when there is no other Mean left to rescue the tender Life of the poor Mother, but by the massacrous Death of her dearest CHILD! This Case indeed would be very Melancholy, but Glory be to GOD who has neither left the One nor the Other to perish at this untimely or inhuman Rate, excepting it be by Ignorance, or Wilfulness, &c. as aforesaid: No, on the contrary he has provided an EXPEDIENT for every Extremity, and a REMEDY for every Malady, as in the present Case will appear farther by what follows, Viz.——
THAT such Tragical Events may be prudently prevented, I use my constant and unwearied Endeavours to sustain the Orifice, that it may not come below its proper Place; and that having clear’d the HEAD of the WOMB, I may only bring it alone down; which I can much more easily do, than if it was cover’d about with the Womb, sticking fast (as above) in the SINUS SACRI. And supposing the MEMBRANE to press strongly instead of the Head, I treat it all one as if it was the Head, taking always Care not to break it, tho’ the forming of the WATERS is not to be obstructed; for which Cause, I upon all Occasions stretch out my Fingers wide, applying them only to the Edges of the Orifice, not to the Membrane: And this I continue doing, until the MEMBRANE spontaneously breaks; upon which I manage the Head as aforesaid.
THUS the Infant’s HEAD being excluded with the Crown foremost, there is no more Occasion to be at any Pains in keeping up the Orifice; wherefore I now suffer it, together with the HEAD, to fall down past the Bending of the OS SACRUM; which now also, the major Part of it being bare, more easily happens, than it possibly could whilst it was cover’d with the Orifice. Upon this, that the Child may be farther relieved and brought out, I now again make use of both Hands, the one inwardly, the other outwardly, as before: But as the Condition is now much alter’d from what it was at that time, I at present proceed after a quite different Manner, and work along with the Pains, resting only as their Force ceases: For thus I not only observe the Pains my self, but also at the same time encourage my Woman to Labour, and to persist in her LABOUR with all her Strength; and by Turns, as the PAINS come on, to conjoin their Force with her own and my mutual Endeavours, in the manner following: namely,
HAVING One Hand in the Vagina, with its Back turn’d towards the Rectum, I thrust very cautiously the Points of my Fingers as far as I can under the HEAD, where I hold that Hand constantly, until the PAIN comes on; laying the other Hand upon the Belly, about that Part where the Bottom of the Womb lies: Then as I perceive the PAINS come on, I begin to work with both Hands; to wit, by pressing the internal Hand gently downwards, against the Point of the Sacrum to remove it back out of the way; whilst by the external Hand, I gently raise the Womb into a resupine Posture, pressing it also softly downwards: I mean softly in Proportion (howsoever) to the Force of the PAIN: for as it gradually encreases, and more and more excites strong Labour; so I also by degrees press down more strongly.
HOWEVER yet the External Depression ought always to be Moderate, as the Internal ought to be Strong and Vigorous: Whereupon Matters being carefully well observ’d, (as laid down in Chap. 9.) no MIDWIFE needs be afraid of hurting her Patient Woman in the least; no rather, on the contrary, the more Strength I use now, the more grateful and agreeable I prove to Her being thus circumstantiated. And, in fine, the upper Part of the CHILD’s Body being once past that Sinuous Bending above, it presently breaks out all together, and comes away so happily into the World. After which the MIDWIFE is only farther to behave herself with respect to both the Mother and the Child, as in the Natural Case[174], carefully cleansing, restoring, contracting, and shutting the Womb as Before. In a Word, with so great Success at last the BIRTH is accomplished, provided these Precepts be carefully and timely observed.
BUT that the Ingenious may be at no Loss in this momentous Affair upon any Occasion, we shall now particularly state the Case, in which the ordinary Midwife has thro’ Ignorance or Negligence, let Matters come so far, that the acuminated or lower Part of the Womb is fallen into the Pelvis; and the Orifice, together with the Head, is broken thro’ into the crooked Sinus of the Os Sacrum, and is fixed-up there; that the Membrane is broke; that the Infant’s Head is but a little bare; that the poor Woman (after the Fatigues of a strong or long Travail) is quite spent and tired; and finally, that all these Things have happen’d before the extraordinary MIDWIFE is perhaps sent for, or at least before He can conveniently be with the Woman.
IN this Pitiful Case, the Head being yet but a little bared, and sticking fast in the Sinus of the Os Coccygis (as abovesaid) the CHILD cannot possibly make any Impression upon the Orifice, so as to open it; and therefore the Situation of the Womb is to be alter’d: In order to which, I first place the Woman on a commodious Seat adapted to the Purpose, such as upon a Pallet, or Low Bed, or some Pillows laid on the Ground; that she may lie with her Face downwards upon her Knees, with her Head low; her Arms being supported with so many Pillows as are requisite to sustain her Body (leaning upon them) without moving.
NOW I doubt not but some People will think this a strange helpless Posture; but as strange as it is, it is certainly the most effectual, and the absolute best One, which can be devis’d for the Woman’s desir’d Relief in this desperate Condition: For by the Help and Means of it, the Womb is carried down into the lowest Part of the Belly, through its own Weight only; and consequently releases itself out of the foremention’d crooked Sinus; which that it may the sooner and more commodiously do, I put my Fingers into the VAGINA behind, betwixt the Rectum and the Head of the Infant, where I press down the Womb, till the Orifice is so far forced back, that there is Room enough to hold it up, in order that it may not relapse; and also that there may be Room for the Head to be depressed into, and open the Orifice. Thus the Womb and the CHILD being at last forced so far back, by an expert Hand, the BIRTH may be successfully perfected by the above-prescrib’d Means and Method; provided always that the Woman has sufficient Strength and PAINS to carry her through the fatiguing Tryal.
BUT we will how suppose, for better Instruction-sake, her Strength to be quite spent, and the PAINS to be deficient; in this Case the happy Issue of the BIRTH is most dubious; but however, then I place the Woman again as before, and depress the Womb as much as I can, until I reduce the Orifice farther up into the larger Space of the PELVIS, that I may the more conveniently open it by the Help of an inward Hand; and by that also moving aside the Child’s Head, I then seek for, until I find, the Feet; which, upon the Infant’s being right turn’d, with its Toes downwards towards the Mother’s Rectum, I bring into the Passage. Now the Feet being thus in the Passage, the Woman needs not lie any longer in the abovesaid Posture; but, turning herself, may now lie with her Face upwards: When I also give her previous Notice to prepare herself to depress vigorously; I mean as much as she can possibly, when occasion requires.
IN the Interim, holding the Feet all the while with my internal Hand, I attract them gently outwards, until the Buttocks and the Belly are excluded: Then taking fast hold of the CHILD by one Hand under the Belly, and the other upon its Back; I advise the good Woman, in Case she feels no PAIN, to behave herself as if the PAINS were most pressing upon Her, and to contribute by forcing downwards what lies in her Power; whilst I continually attract, and gently draw the Infant towards me, until by this discreet Management the Head is totally excluded, together with the Arms into the World. And thus at length the Distressed Woman may be happily delivered in all these different Cases, and difficult Conditions of Life. Whence I come to——